Michael R. McCart

Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial

Despite the serious and costly problems presented by juvenile sexual offenders, rigorous tests of promising interventions have rarely been conducted. This study presents a community-based effectiveness trial comparing multisystemic therapy (MST) adapted for juvenile sexual offenders with services that are typical of those provided to juvenile sexual offenders in the United States. Youth were randomized to MST (n = 67) or treatment as usual for juvenile sexual offenders (TAU-JSO; n = 60). Outcomes through 12 months postrecruitment were assessed for problem sexual behavior, delinquency, substance use, mental health functioning, and out-of-home placements. Relative to youth who received TAU-JSO, youth in the MST condition evidenced significant reductions in sexual behavior problems, delinquency, substance use, externalizing symptoms, and out-of-home placements. The findings suggest that family- and community-based interventions, especially those with an established evidence-base in treating adolescent antisocial behavior, hold considerable promise in meeting the clinical needs of juvenile sexual offenders.

Mediators of Change for Multisystemic Therapy with Juvenile Sexual Offenders

The mediators of favorable multisystemic therapy (MST) outcomes achieved at 12 months postrecruitment were examined within the context of a randomized effectiveness trial with 127 juvenile sexual offenders and their caregivers. Outcome measures assessed youth delinquency, substance use, externalizing symptoms, and deviant sexual interest/risk behaviors; hypothesized mediators included measures of parenting and peer relations. Data were collected at pretreatment, 6 months postrecruitment, and 12 months postrecruitment. Consistent with the MST theory of change and the small extant literature in this area of research, analyses showed that favorable MST effects on youth antisocial behavior and deviant sexual interest/risk behaviors were mediated by increased caregiver follow-through on discipline practices as well as decreased caregiver disapproval of and concern about the youths bad friends during the follow-up. These findings have important implications for the community-based treatment of juvenile sexual offenders.

Do Urban Adolescents Become Desensitized to Community Violence? Data From a National Survey

This study explored whether the response of urban adolescents to community violence exposure differs from their response to family violence and sexual assault. More specifically, the authors explored whether desensitization to community violence exposure was more common compared with desensitization to other violence-related stressors. Participants included 1,245 urban adolescents drawn from a national probability sample of 4,023 youth (aged 12-17 years) who were interviewed about their history of interpersonal violence exposure, symptoms of posttraumatic stress disorder (PTSD), and delinquency. A negative curvilinear effect of community violence exposure on PTSD combined with a positive linear effect of exposure on delinquency was considered evidence for desensitization. Results provided minimal support for the desensitization hypothesis and revealed increasing levels of PTSD symptoms and delinquent behaviors among boys and girls exposed to higher levels of all three violence types.

Longitudinal pathways of victimization, substance use, and delinquency: findings from the National Survey of Adolescents.

Using a nationally representative sample of 3614 adolescents, age 12 to 17 years, this study examines longitudinal associations among interpersonal victimization (i.e., sexual abuse, physical abuse and/or assault, and witnessed community and domestic violence) and high risk behavior (i.e., alcohol use, drug use, and delinquent behavior). A bidirectional relationship was hypothesized between high risk behavior and victimization for the full sample. Descriptive results indicated that a high correlation between types of high risk behavior, with over 50% of adolescents having engaged in at least one type of high risk behavior by Wave 2 in the study. Results suggested strong links between victimization and high risk behaviors, whereas sequential order of the constructs across time was dependent on gender and type of victimization. Specifically, hypotheses concerning victimization and high risk behavior were fully supported with boys, but different patterns emerged in the data for girls.

Depression and Delinquency Covariation in an Accelerated Longitudinal Sample of Adolescents

OBJECTIVES The current study tested opposing predictions stemming from the failure and acting out theories of depression-delinquency covariation. METHOD Participants included a nationwide longitudinal sample of adolescents (N = 3,604) ages 12 to 17. Competing models were tested with cohort-sequential latent growth curve modeling to determine whether depressive symptoms at age 12 (baseline) predicted concurrent and age-related changes in delinquent behavior, whether the opposite pattern was apparent (delinquency predicting depression), and whether initial levels of depression predict changes in delinquency significantly better than vice versa. RESULTS Early depressive symptoms predicted age-related changes in delinquent behavior significantly better than early delinquency predicted changes in depressive symptoms. In addition, the impact of gender on age-related changes in delinquent symptoms was mediated by gender differences in depressive symptom changes, indicating that depressive symptoms are a particularly salient risk factor for delinquent behavior in girls. CONCLUSION Early depressive symptoms represent a significant risk factor for later delinquent behavior--especially for girls--and appear to be a better predictor of later delinquency than early delinquency is of later depression. These findings provide support for the acting out theory and contradict failure theory predictions.

Help Seeking Among Victims of Crime: A Review of the Empirical Literature

The authors review the literature on help-seeking behavior among adult victims of crime. Specifically, they summarize prevalence rates for formal and informal help seeking and review predictors of and barriers to service use following victimization. Research suggests that only a small fraction of crime victims seek help from formal support networks; however, many seek support from informal sources. Several variables are associated with increased likelihood of formal help seeking, although the manner in which these variables affect reporting behavior is not clear. From this review, it is concluded that much remains to be learned regarding patterns of help seeking among victims of crime. Gaps in the literature and directions for future research are discussed.

Prevalence and Impact of Substance Use Among Emerging Adults with Serious Mental Health Conditions

TOPIC This critical review of the literature integrates findings across varied literatures and identifies areas for continued study on the prevalence, correlates, and impact of substance use (alcohol and illicit drugs) on social role functioning among emerging adults with serious mental health conditions. PURPOSE This population is of interest because of high comorbidity rates between substance use and serious mental health conditions and the added difficulties posed by their co-occurrence during the transition to adulthood. This critical review presents the epidemiology of substance use in emerging adults with serious mental health conditions compared to emerging adults without these conditions, as well as what is known about predictors and consequences of substance use in this population. SOURCES USED PsychINFO and PubMed along with relevant published literature. RESULTS This review summarizes what is known about the impact of these co-occurring problems on the transition of emerging adults from school and training environments to adult work roles. Though this group presents with unique challenges, few programs have been developed to address their specific needs. This paper synthesizes what is known empirically about approaches with this population, discussing those that might be useful for emerging adults with comorbid serious mental health conditions and substance use problems, particularly in supporting their educational and vocational development. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Emerging adults with co-occurring serious mental health conditions and substance use problems are underserved by current mental health systems. Recommendations focus on how to promote mental health and social role functioning through comprehensive intervention programs that provide continuity of care through the transition to adulthood.

Two-year follow-up of a randomized effectiveness trial evaluating MST for juveniles who sexually offend.

Building on prior efficacy trials (i.e., university-based, graduate students as therapists), the primary purpose of this study was to determine whether favorable 12-month outcomes, obtained in a randomized effectiveness trial (i.e., implemented by practitioners in a community mental health center) of multisystemic therapy (MST) with juveniles who had sexually offended (JSO), were sustained through a second year of follow-up. JSO (n = 124 male youth) and their families were randomly assigned to MST, which was family based and delivered by community-based practitioners, or to treatment as usual (TAU), which was primarily group-based cognitive-behavioral interventions delivered by professionals within the juvenile justice system. Youth averaged 14.7 years of age (SD = 1.7) at referral, were primarily African American (54%), and 30% were Hispanic. All youth had been diverted or adjudicated for a sexual offense. Analyses examined whether MST effects reported previously at 1-year follow-up for problem sexual behaviors, delinquency, substance use, and out-of-home placement were sustained through a second year of follow-up. In addition, arrest records were examined from baseline through 2-year follow-up. During the second year of follow-up, MST treatment effects were sustained for 3 of 4 measures of youth problem sexual behavior, self-reported delinquency, and out-of-home placements. The base rate for sexual offense rearrests was too low to conduct statistical analyses, and a between-groups difference did not emerge for other criminal arrests. For the most part, the 2-year follow-up findings from this effectiveness study are consistent with favorable MST long-term results with JSO in efficacy research. In contrast with many MST trials, however, decreases in rearrests were not observed.

Enhancing the effectiveness of juvenile drug courts by integrating evidence-based practices.

OBJECTIVE The primary purpose of this study was to test a relatively efficient strategy for enhancing the capacity of juvenile drug courts (JDC) to reduce youth substance use and criminal behavior by incorporating components of evidence-based treatments into their existing services. METHOD Six JDCs were randomized to a condition in which therapists were trained to deliver contingency management in combination with family engagement strategies (CM-FAM) or to continue their usual services (US). Participants included 104 juvenile offenders (average age = 15.4 years; 83% male; 57% White, 40% African American, 3% Biracial). Eighty-six percent of the youths met criteria for at least 1 substance use disorder, and co-occurring psychiatric diagnoses were highly prevalent. Biological and self-report measures of substance use and self-reported delinquency were assessed from baseline through 9 months postrecruitment. RESULTS CM-FAM was significantly more effective than US at reducing marijuana use, based on urine drug screens, and at reducing both crimes against persons and property offenses. Such favorable outcomes, however, were not observed for the self-report measure of substance use. Although some variation in outcomes was observed between courts, the outcomes were not moderated by demographic characteristics or co-occurring psychiatric disorders. CONCLUSIONS The findings suggest that JDC practices can be enhanced to improve outcomes for participating juvenile offenders. A vehicle for promoting such enhancements might pertain to the development and implementation of program certification standards that support the use of evidence-based interventions by JDCs. Such standards have been fundamental to the successful transport of evidence-based treatments of juvenile offenders.

Has Adolescent Suicidality Decreased in the United States? Data from Two National Samples of Adolescents Interviewed in 1995 and 2005.

We compared the prevalence and correlates of adolescent suicidal ideation and attempts in two nationally representative probability samples of adolescents interviewed in 1995 (National Survey of Adolescents; N = 4,023) and 2005 (National Survey of Adolescents-Replication; N = 3,614). Participants in both samples completed a telephone survey that assessed major depressive episode (MDE), post-traumatic stress disorder, suicidal ideation and attempts, violence exposure, and substance use. Results demonstrated that the lifetime prevalence of suicidal ideation among adolescents was lower in 2005 than 1995, whereas the prevalence of suicide attempts remained stable. MDE was the strongest predictor of suicidality in both samples. In addition, several demographic, substance use, and violence exposure variables were significantly associated with increased risk of suicidal ideation and attempts in both samples, with female gender, nonexperimental drug use, and direct violence exposure being consistent risk factors in both samples.